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All APPLICABLE INFO MUST BE COMP FOR APPLICATION TO BE ACCEPTED —7
Date: ,r I Z DID' Permit Number:
oom
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PER(t%IITTYPE: �Sro;e_n 41G,_-�'
P O.P05ED.1MPROVEMENT LOCATION;
Address: �} C q l�A_1,,t _)cock_ �'uz
Property Tax ID#: Z24f-� 7- !20 0 -, Lot No. 1:5—
Site Plan Name: r -k-� 1.��' P" g-r� z �r!J Block No.
Project Name: I�r'j n ,,mod c ,- J d A
DEl"AIt,ED DE5CRIPTION OF WDftK " r }3. M.r73,� •L1..7.1, a� _,.i�.1.,.. 7:. ..3r�. .r
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CONSTRIJCT(ON INFORMATION. -rr� i �
Additional work to be performed under this permit—check all that apply:
Mechanical _Gas Tank _Gas Piping Shutters Windows/Doors
v"Electric Plumbing ^Sprinklers ^Generator = Roof 4 'f-L Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
1 t/
Cost of Construction:$ Utilities: —Seaver -V S ptic Building Height: /' i
Q.It1JNER/LES5EE 's , ; `' ?� CONTRACTOR 4 5
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Name t >=V1C4 Y t 1.i`±rn+ S._ ��'.rel���r7.�sC: ( .1� Name:_ e�1 �: pl�;�
Address:
City: ,^K State: Address: ` ?. �' l';,�vta,�^ ��1, ' , I'�
Zip Code:` f--r`1 Fax: 11 L 12 1. `:��;S`J City: ;..%., State Ft—
Phone No. '7 .) {AtA• `�rS��{� _ Zip Code 1..._14C9 l> } Fax: 'If 7,1_ 6 -a
E-Mail: ��%3..i t� 7 Lei �� rt,f?ram, .`5 C G y7 Phone No 'f ' �a�t„) fGr-n
Fill in fee simple Title Holder on next page(if different E-Mail
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from the Owner listed above) State or County License L s 41. /�� l,,'L q,�
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
If value of HVAC is$7,500 or more',a RECORDED Notice of Commencement is required.
SIPPLEMENTALONSTRUCTlON LIEN lAW If�F�RIV1AT14N;
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DESIGNER/ENGINEER: r Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City:. State:-
Zip: Phone Zip: Phone.
FEE SIMPLE TITLEHOLDER: —Not Applicable. BONDING COMPANY: ____Not Applicable
Name; Name:
Address: Address:
City: City:
Zip: Phone; Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made-to obtain a'permit to do the work and installation as indicated.
I certify that no work'or Installation has commenced prior to the issuance of a permit.
St.Lucie County makes no represet�tationthat is granting a permit will authorize the permit holder to build the subject structure
whlch Is in conflict with any applicable Home Owners Association rules,bylaws or and,covenants that may restrict or prohibit such
structure.Please consult with your Home Owners Association and review your deed for any restrictions which may apply:
In consideration of the granting of this requested permit,I do hereby agree that i will,in all respects,perform the work
In accordance with the approved plans,the Florida,Building Codes and St.Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of.Commencement may result In your paying twice for
improvements to your property.A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing,consult with lender or an attorney before
com mencing work or recording our Notice of Commencement.
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Signature o Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Ho der..
STATE 00FLORIDA ? STATE OF FLORIDA
COUNTY-OF COUNTYOF ��` �cf6C-J-!'
'Tha forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
thin/L} day of 06 f 20&) by .this, /6 day of QC-1, 20 ZU by
/L r.s a t rl. i`n.l, L' '1e.-r�i\ A _I_)A v1�S ..'
Name of person aking statement Name of person making statement
Personally Known ''�OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
,.A-'ri_Cn"?ai
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
`v P RHONDA$ROWE v AI
u�l RHONDAS ROWE
Commission o: tigG1tl) Commissi °Jior ommisalorGG1QA6geal)
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Expires t — play i9,2021 N Expires May 19,2021
N9 0 4 Bondao7hu6ud eiYctarySonices �rF ae�4 0ondx}iANBuGflalNcte76ervkas
REVIEWS FRONT ZONING SUPERVISOR. PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17